Reimbursement process of hospitalization medical insurance

Legal analysis: 1. After the insured patients are hospitalized for trauma that meets the scope of compensation, their families should report to the village (neighborhood) committee (work unit) or township labor insurance (formerly agricultural medicine) where the household registration is located within 48 hours. 2, patients or their relatives in the county designated medical institutions to receive the Yongfeng County basic medical insurance industrial injury medical treatment audit table "(hereinafter referred to as the" audit table "), which is hospitalized outside the county in the domicile of the township labor insurance office to receive free of charge. Designated medical institutions shall truthfully fill in the cause of injury, diagnosis and treatment, and investigation, and submit the audit form to the village (neighborhood) committee or work unit where the household registration is located, the township labor insurance office, and the county medical insurance bureau for the investigation and audit procedures for the trauma of the insured patients. 3, patients or their relatives in the audit table, truthfully fill in the patient's basic situation, the cause of the incident, time, place, after the injury, and make my statement of the above facts, immediate family members guarantee. 4. The attending physician of the designated medical institution shall truthfully fill in the cause of injury and diagnosis and treatment on the audit form, which shall be signed by the head of the department, carefully investigated and verified by the head of the medical insurance office, and signed and sealed by the leaders in charge of the medical institution. 5. The village (neighborhood) committee or work unit needs to send people to conduct serious investigation and verification. If the injury really falls within the scope of compensation, it should truthfully fill in the investigation opinions, and the village secretary or director and accountant of the village (neighborhood) committee should fill in (2 cadres) for signature and confirmation, and affix the official seal. 6. The township labor insurance office further verifies whether the investigation results are true, and the staff of the township labor insurance office truthfully fills in the investigation and verification opinions, is in charge of the leadership review and signs and seals the investigation conclusions. Within 7.2 working days (weekends, holidays postponed), the attending doctor should inform the medical insurance reimbursement personnel of our hospital of the admission place, the cause of the patient's injury and other relevant information in time, and the medical insurance reimbursement personnel will report the patient's name, home address, department bed number and reasons for private prosecution to the county medical insurance bureau audit unit for the record. 8, patients in the county designated medical institutions hospitalization, after discharge by the designated medical institutions in accordance with the provisions of reimbursement of medical expenses; In the medical institutions outside the county for hospitalization, after discharge, they will go back to the township labor insurance office to go through the relevant formalities according to the regulations with relevant information, and the workers will be sent to the county medical insurance bureau to go through the relevant formalities according to the regulations. 9, hospitalized in township hospitals, with township hospitals, village (neighborhood) committees (work units) and township labor insurance survey and verification opinions, which belong to the scope of compensation can be compensated according to the relevant provisions of the compensation ratio. 10, the total medical expenses of county-level designated medical institutions is 10000 yuan, with medical institutions, village (neighborhood) committees (work units) and township labor insurance offices as direct reporting units; If the total medical expenses exceed 10000 yuan, they shall be sent to the audit unit of the county medical insurance bureau to further verify the cause of the injury. After the signature and seal of the county medical insurance bureau, the designated institutions shall go through the compensation procedures. 1 1. If you are hospitalized in a designated institution outside the county, you can collect it from the township labor insurance office, fill in the audit form truthfully, send it to the village (neighborhood) Committee (work unit) and the township labor insurance office for investigation, verification and seal, and report it to the medical insurance bureau for audit. After the medical insurance bureau signs and seals, the township labor insurance office shall go through the compensation procedures.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

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The above answer is only for the current information combined with my understanding of the law, please refer carefully!

If you still have questions about this issue, I suggest you sort out relevant information and communicate with professionals in detail.